Basic Information
| Provider Information | |||||||||
| NPI: | 1861807414 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VON BERGEN | ||||||||
| FirstName: | TOBIAS | ||||||||
| MiddleName: | NIKOLAUS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 CIRCLE 75 PKWY SE STE 1700 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303393087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709536929 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1240 EAGLES LANDING PKWY STE 300 | ||||||||
| Address2: | |||||||||
| City: | STOCKBRIDGE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302815173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705064350 | ||||||||
| FaxNumber: | 7705069860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2014 | ||||||||
| LastUpdateDate: | 09/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 86346 | GA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 2019-00768 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 86346 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
No ID Information.